| NPI | 1114648045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEMBERLY LILES RAINNEY Clinical Consultant 804-248-6964 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2022-09-08 |
| Last Update Date | 2022-09-08 |